Dr. April Gamble and a Team of Passionate Clinicians Complete the Pain Education Grant in Kurdistan, Iraq

Jul 28, 2020

IASP is excited to report on the work of 2019 Developing Countries Project: Initiative to Improve Pain Education Grant recipient, Dr. April Gamble, PT, DPT, CLT. The Developing Countries Project: Initiative to Improve Pain Education Grant facilitates the creation of pain education programs in developing countries. Types of grant projects include combining practical instruction with the latest research, developing written teaching materials, creating online learning programs, or developing or implementing policy changes on pain education and practice in hospitals, universities, governments, or other places. 

IASP: What was your project? What did it aim to accomplish?

Gamble: Our project was titled "Building Capacity in Pain Science for Physiotherapists working with Vulnerable Populations in the Semi-Autonomous Kurdistan Region of Iraq" and aimed to accomplish the following:

  • Develop a pain science curriculum and training manual that is culturally and contextually relevant
  • Disseminate the pain science curriculum and training manual in English, Kurish Sorani, and Arabic
  • Equip 13 physiotherapists from all four governorates of Kurdistan with the knowledge, skills, and abilities to teach the pain science curriculum via a Training of Trainers (TOT) Workshop
  • Equip at least 280 physiotherapists in the knowledge, skills, and abilities from the pain science curriculum
  • Integrate the pain science curriculum into the only bachelor's degree of physiotherapy program in Kurdistan

Were you able to accomplish these objectives?

Gamble: Overall, yes. We held a TOT workshop in Erbil in late 2019 where we trained 17 participants including physiotherapists and physicians from three different communities in Kurdistan. Participants reported a 42% change between pre- and post-tests evaluating their knowledge about theories of pain and the neurobiology of pain. Following the TOT workshop, these trained professionals then conducted community-based trainings for 114 physiotherapists. Although COVID-19 prevented additional courses from being held, the community trainers are currently recording video lectures in Kurdish Sorani and Arabic so these can be made available online for physiotherapists in the Kurdistan Region and for professionals throughout the Middle East Region.

What material has been developed as a result of this grant?

Gamble: With the Developing Countries Pain Education Grant, we completed "Beyond Pain©: An Evidence-Based and Multilingual Biopsychosocial Pain Science Training and Treatment Manual."

Beyond Pain©  is available for free download here. It is a unique resource as the content and style are designed to meet the learning needs, culture, and context of healthcare professionals in the Middle East Region. For example, Part 4 of Beyond Pain© is a treatment manual that integrates metaphors, stories and analogies to explain pain. These were all developed with physios and clients in the Middle East, so they are specific and relevant to this context and culture. 

This was developed in partnership with the following pain science experts: 

  • Anne-Mette Karrer - Physiotherapist, International Rehabilitation Trainer at DIGNITY – Danish
    Institute Against Torture
  • Jessica E. Lambert PhD – Psychologist and Senior Research at DIGNITY – Danish
    Institute Against Torture
  • Kathy Clark PT, MS, DPT - Physiotherapist, Educational Director at Boston Biopharma
  • Leonard Van Gelder PT, DPT, ATC, TPS, CSMT, CSCS - Physiotherapist, founder of Dynamic
    Principles which provides science-based, practical continuing education for healthcare and
    movement professionals that is rooted in a biopsychosocial framework, and Owner of Dynamic
    Movement and Recovery, a biopsychosocial-oriented clinical practice

What are the long-term implications for this project? 

Gamble: It feels that this is the beginning of a pain revolution in the Kurdistan Region. The community trainers throughout Kurdistan are now passionate champions for modern pain science. They are exploring innovative ways to work alongside their communities to deliver treatment services that can better support persons struggling with pain.

The head of the physiotherapy department at Erbil Polytechnic University, Dr. Mahdi Khaled Qadir M.B.Ch.B/H.D.R.M.R, attended the TOT workshop. Two additional teachers in this department also attended the TOT workshop. This is the only bachelor’s degree in Physiotherapy program in Kurdistan and Dr. Mahdi and I are working on integrating the curriculum into the Bachelor's degree. We hope that this will result in long-term sustainable changes in how pain is understood and treated within the region.